Middle Third fractures Flashcards by Mehrpreet Saluja

Guerin Fracture is another name for

Lefort 1 also called as
horizontal or telescopic fracture
or Floating Maxilla fracture

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Criteria for Glasgow Comma scale

Motor response
Verbal performance
eye opening

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HALO ON PILLOW or Tramline effect is seen in

CSF rhinorrhea - Nasoethmoidal , lefort 2 and 3 fractures

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CSF biochemical analysis in case of rhinorrhea is

Beta 2 transferrin (also present in perilymph and aqueous humour)

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Beta 1 transferrin is seen in

Nasal secretions
Tears
Saliva

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Management of CSF rhinorrhea

Bed rest, head elevation, fluid restriction, avoid nasal blowing, VALSAVA

Mannitol 100 ml IV
Acetazolamide
Antibiotics - Cephalosporins
Spontaneous closure within 1 week

lumbar drainage - next week
surgical - 3rd week

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Epiphora seen in

Lefort 3

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Athens displaced Zygomatic complex can be reduced by

Gillies Temporal Approach (GTA)

intraoral approach is Keen’s technique

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Lefort 3 involves

Maxilla
Lacrimal
Nasal
Ethmoidal bones

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Lefort 2 involves

Maxilla
Nasal
Lacrimal bones

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Rowe’s Disimpaction forceps are used for

Reducing the tooth bearing portion of the upper jaw

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Bristowe’s Elevator used for

elevating Fractured zygomatic bone

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Asche’s / Walsham forceps is used for

Reduction of nasal complex fractures

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For hypovolemic shock post trauma what solution is infused IV?

Ringer Lactate due To it’s high osmotic value maintains fluid in vascular compartment.

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Hess Chart measures….?

The degree of diplopia I. maxillofacial trauma accurately

seen in - Zygomatic complex, lefort 2 And 3 # - passing Whitnells tubercle

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Lefort 3 is also called …. when fracture line runs from fronto nasal suture transversely backward parallel with the base involving Ethmoidal bone and cribriform plate

Craniofacial Dysjunction

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Moon face appearance seen in

Lefort 2 and 3

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Patient with maxillofacial trauma requires …. mmol of sodium

100

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Patient with maxillofacial trauma requires …. mmol of potassium

60 mmol

Gillies approach uses ….. Elevator

Bristowe’s Elevator

Zygomatic nerve supplies

Temple
Cheek
one side of upper lip
and side of 👃

Diplopia occura due to injury of

Inferior rectus

secondly inferior oblique

Ye most accurate diagnostic criteria for blowout fracture of orbital floor consists of

2 mm thick section of sagittal CT scans
and
lateral Hyppcycloidal tomograms

Treatment of Blowout Fracture of orbital floor should be made within

not before 10 days - edema to subside
2-3 weeks of injury
ENOPTHALMOSOUS greater than 3 mm

Grafts for orbital floor reconstruction

Alloplastic- Teflon , polyvinyl sponge Allogenic- allogenic bone Autologous - illiac crest

In traumatic telecanthus the intercanthal distance is increased to

35-40 mm

Fir diagnosis of Nasal Fractures

True Lateral and | 15 - 30 degrees occipitomental projection

Redness in conjunctiva remains bright red due to

oxygenation of HB can take place through thin conjunctiva

Dautry procedure is used in

Chronic Subluxation of TMJ - Zygomatic arch is pushed down infront of Condyle - prevents dislocation to occur

Lefort 1 Osteotomy comprises of .... bones

5 two maxilla vomer pterygoid plates

Surgical approach for Frontonasal area is best by

Coronal method

Bicoronal approach gives best exposure to.... complex

Nasoethmoidal complex

Tetrapod of zygomatic fracture includes

Infraorbital rim - Infraorbital foramen Lateral Orbital Wall Zygomaticomaxillary buttress Zygomatic arch (thin posterior)

Latency Phase of fracture healing lasts

5-7 days | but patients younger than 4-5 yrs have 0-2 days

Three Variables of distraction include

Rate Rhythm Time

Rate of distraction in young children is

2mm/day in adults it's 1 mm/d geriatric patients 0.5 mm/d

Vascularity of Lefort 1 Osteotomy segment is by

Ascending Palatine | ascending pharyngeal of facial artery

Elevation of zygomatic arch is confirmed by

Audible crunch OR crack sound

Exophthalmos is seen in

Blow in # Thyrotoxicosis Grave's Disease Medullary Carcinoma

Combitube method of intubation is contraindicated in

Patients with innate gag reflex and in rare circumstance of caustic ingestion. Not used in patients with notable upper airway or neck trauma, since placement is blind and may cause iatrogenic injury

Fiber-optic intubating bronchoscope can be used in

suspected cervical spine injury

Illizarov principal or distraction osteogenesis works on the principle of

law of Tension- stress meaning by gradual traction on living tissues created stresses that stimulate regeneration and active growth of certain structures

...... nervw injury is most common with transverse fracture of temporal bone

Facial nerve

In CSF levels of these enzymes indicate injury

LDH - Lactate Dehydrogenase | CK- creatinine kinase

Most common of facial fractures is

Nasal bone fracture

Antimongoloid slant is due to

downward displacement of zygoma a slant to the lateral canthus, ENOPTHALMOS and accentuation of supra tarsal fold of upper eyelid. seen in LEFORT 3 Craniofacial dysostosis - Crouzon syndrome mandibulofacial dysostosis - Teacher Collins Franacetti syndrome